abstract: 'Purpose Over 50\% of breast cancer patients prescribed a 5-year course

  of daily oral adjuvant endocrine therapy (ET) are nonadherent. We

  investigated the role of costs and cancer medication delivery mode and

  other medication delivery factors on adherence. Methods We conducted a

  retrospective cohort study of commercially insured and Medicare

  advantage patients with newly diagnosed breast cancer in 2007-2015 who

  initiated ET. We examined the association between 12-month ET adherence

  (proportion of days covered by fills >= 0.80) and ET copayments, 90-day

  prescription refill use, mail order pharmacy use, number of pharmacies,

  and synchronization of medications. We used regression models to

  estimate nonadherence risk ratios adjusted for demographics (age,

  income, race, urbanicity), comorbidities, total medications, primary

  cancer treatments, and generic AI availability. Sensitivity analyses

  were conducted using alternative specifications for independent

  variables. Results Mail order users had higher adherence in both

  commercial and Medicare-insured cohorts. Commercially insured patients

  who used mail order were more likely to be adherent if they had low

  copayments (< \$5) and 90-day prescription refills. For commercially

  insured patients who used local pharmacies, use of one pharmacy and

  better synchronized refills were also associated with adherence. Among

  Medicare patients who used mail order pharmacies, only low copayments

  were associated with adherence, while among Medicare patients using

  local pharmacies both low copayments and 90-day prescriptions were

  associated with ET adherence. Conclusion Out-of-pocket costs, medication

  delivery mode, and other pharmacy-related medication delivery factors

  are associated with adherence to breast cancer ET. Future work should

  investigate whether interventions aimed at streamlining medication

  delivery could improve adherence for breast cancer patients.'
affiliation: 'Neuner, JM (Corresponding Author), Med Coll Wisconsin, Div Gen Internal
  Med, Milwaukee, WI USA.

  Neuner, Joan M., Med Coll Wisconsin, Div Gen Internal Med, Milwaukee, WI USA.

  Neuner, Joan M.; Fergestrom, Nicole; Laud, Purushottam W., Med Coll Wisconsin, Ctr
  Adv Populat Sci, Milwaukee, WI USA.

  Pezzin, Liliana E., Med Coll Wisconsin, Inst Hlth \& Equity, Milwaukee, WI USA.

  Laud, Purushottam W., Med Coll Wisconsin, Div Biostatist, Milwaukee, WI USA.

  Ruddy, Kathryn J., Mayo Clin Rochester, Div Med Oncol, Rochester, MN USA.

  Winn, Aaron N., Med Coll Wisconsin, Sch Pharm, Milwaukee, WI USA.'
author: Neuner, Joan M. and Fergestrom, Nicole and Pezzin, Liliana E. and Laud, Purushottam
  W. and Ruddy, Kathryn J. and Winn, Aaron N.
author-email: jneuner@mcw.edu
author_list:
- family: Neuner
  given: Joan M.
- family: Fergestrom
  given: Nicole
- family: Pezzin
  given: Liliana E.
- family: Laud
  given: Purushottam W.
- family: Ruddy
  given: Kathryn J.
- family: Winn
  given: Aaron N.
da: '2023-09-28'
doi: 10.1007/s10549-022-06704-2
earlyaccessdate: NOV 2022
eissn: 1573-7217
files: []
issn: 0167-6806
journal: BREAST CANCER RESEARCH AND TREATMENT
keywords: Breast cancer; Medication adherence; Cost-related nonadherence
keywords-plus: 'HORMONAL-THERAPY; WOMEN; SYMPTOMS; SUPPORT; DISCONTINUATION;

  NONADHERENCE; TAMOXIFEN; SURVIVORS; CARE'
language: English
month: JAN
number: '1'
number-of-cited-references: '42'
orcid-numbers: Neuner, Joan/0000-0003-0031-5988
pages: 223-233
papis_id: 7924be5e60cec03badb84c850ea1429f
ref: Neuner2023medicationdelivery
times-cited: '3'
title: Medication delivery factors and adjuvant endocrine therapy adherence in breast
  cancer
type: article
unique-id: WOS:000882261500001
usage-count-last-180-days: '0'
usage-count-since-2013: '1'
volume: '197'
web-of-science-categories: Oncology
year: '2023'